Maréchaux S, et al. - In this multicenter study involving 983 consecutive patients (mean age 75 ± 11 years), researchers compared the outcome of patients with normal flow high gradient and low flow, defined by Doppler echocardiography as a stroke volume index < 30 mL/m² or a stroke volume < 55 mL, high gradient severe aortic stenosis (SAS) with no or minimal symptoms. The study sample consisted of individuals with asymptomatic or minimally symptomatic HG (mean pressure gradient ≥ 40 mm Hg) SAS with preserved left ventricular ejection fraction. Two hundred twenty-five patients died during a median follow-up period of 48 (45–52) months. Compared with normal flow high gradient SAS, the 60–month mortality was higher in low flow high gradient SAS. At follow-up, asymptomatic or minimally symptomatic patients with low flow high gradient SAS and preserved left ventricular ejection fraction have a considerably increased mortality risk. Such individuals should be promptly considered for aortic valve replacement.